title: Prognostic risk factors of early esophageal adenocarcinomas.
abstract: OBJECTIVE
  To define prognostic risk factors in patients with early adenocarcinomas of the esophagus (eACEs) who were treated by esophagectomy.
  
  
  BACKGROUND
  Although endoscopic resection (ER) is more accepted for eACEs limited to the mucosa, the reported prevalence of lymph node metastases once the tumor infiltrates the submucosa seems to necessitate surgery in these cases.
  
  
  METHODS
  We analyzed the results of 168 patients who had an esophageal resection because of an eACE. On the basis of specimen histologies and clinical follow-up (median, 64 months), we investigated the influence of lymph node metastases (N+), tumor infiltration depth, tumor differentiation (G1-3), and lymphatic or venous infiltration (L+ or V+) on overall and tumor-specific survival and recurrence rates.
  
  
  RESULTS
  The 5-year survival rate was 79%. Lymph node infiltration was the only prognostic factor for the overall survival [hazard ratio (HR), 2.856; 1.314-6.207; P = 0.008], tumor-specific survival (HR, 8.336; 2.734-25.418; P < 0.001), and tumor recurrence (HR, 8.031; 3.041-21.206; P < 0.001) that was consistently present in all multivariate hazard Cox regression analyses. A total of 47% of the patients who had an N+ status developed tumor recurrences compared with 5.2% of those who had no lymph node involvement (P = <0.001). We found a significant correlation between N+ status and increasing depth of tumor infiltration (P = 0.004), lymphatic vessel infiltration (P = 0.002), tumor differentiation (G1 + G2 vs G3; P = 0.014) and vascular infiltration (P = 0.01).
  
  
  CONCLUSIONS
  Lymph node status is the only independent risk factor for survival and recurrence rates. Tumor infiltration depth correlates with the rate of the lymph node metastases, but a clear watershed between deep mucosal and submucosal infiltration does not exist. As a consequence, careful staging procedures, including diagnostic ER, are mandatory to determine which patients can be treated by ER and which require an esophagectomy.
authors.affiliation: *Departments of Surgery †Pathology, and ‡Gastroenterology, Dr Horst-Schmidt-Klinik, Wiesbaden, Germany; and §Department of Pathology, Klinikum Kulmbach, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Lorenz
authors.forename: Judith
authors.initials: J
authors.lastname: Origer
authors.forename: Michael
authors.initials: M
authors.lastname: Pauthner
authors.forename: Florian
authors.initials: F
authors.lastname: Graupe
authors.forename: Annette
authors.initials: A
authors.lastname: Fisseler-Eckhoff
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Oliver
authors.initials: O
authors.lastname: Pech
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends